Provider Demographics
NPI:1275007270
Name:PARENTO, THEODORE JOHN
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:JOHN
Last Name:PARENTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 SNYDER AVE BLDG 17
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-6752
Mailing Address - Country:US
Mailing Address - Phone:775-887-3285
Mailing Address - Fax:
Practice Address - Street 1:5500 SNYDER AVE BLDG 17
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-6752
Practice Address - Country:US
Practice Address - Phone:775-887-3285
Practice Address - Fax:775-887-3253
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV811873363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health